Correctional Medicine Claims Research Specialist Needed in Nashville,
Posted on: November 22, 2020
Here at Wellpath, everything that we do is about taking care of
people - our patients, our staff and our partners. We are committed
to making a difference by providing hope and healing to vulnerable
patients in challenging clinical environments. Our talented,
compassionate team thrives in an autonomous environment, is
empowered and supported by education, training and the resources to
practice healthcare the way it is meant to be and strives to
"Always Do The Right Thing!" Our Claims Research Specialist is the
face of the claims department to providers and customers in
contacting Wellpath for questions regarding claims authorization,
payment and related workflows. They document calls issues, insure
follow-up and proper resolution of all complaints and
- Associates degree or similar medical claims
- Excellent written and verbal communication skills
- Three (3) or more years of medical claims investigation
- Prior experience on the phones researching and resolving claims
- Strongly analytical, research and problme solving
- None required
- Receive calls from providers and customers dealing with medical
- Document each call in salesforce review/track all
- Resolve all claims issues by performing all necessart research
and comunicate solutions in response to customer
- Triage issues and determine for cross-functional department
involvement in resolving billing claims issues.
- Research and answer questions from providers, customers or
sites regarding claims payment, eligibly and authorizations for
- Be warm, helpful and respectful to all callers. Demonstrate the
5H's in all interactions with others.
- Build, develop, and maintain relaionships with all participants
(providers, customers, administrators, and sites) through claims
- Clearly, unambiguously and truthfully communicate with callers,
internal resources and others.
- Understand and demonstrate mastery in understanding Wellpath
workflows, processes and systems involved in the eligibility,
authorization and claims payment processes.
- Utilize necessary resources and navigate systems efficiently to
accurately verify eligibility, claim status, appeal status, and
- Must understand Third Party Administrating concepts.
- Must have strong organizational skills, problem solving and
decision making skills. Knowledge in excel and Word. Ability to
navigate through and utilize various PC applications. Professional
interaction, active and passive listening skills.
- Self-direction and self-starter skills required. Be able to
adequately multitask while maintaining quality and accuracy.
- Must be able to apply principles of critical thinking to a
variety of practical and emergent situations and accurately follow
standardized procedures that may call for deviations.
- Must be able to apply sound judgment beyond a specific set of
instructions and apply knowledge to different factual
- Must be alert at all times; pay close attention to
- Must be able to work under stress on a regular or continuous
- Demonstrate esprit de corps in all areas.
- Perform other duties as assigned.Wellpath is an
EOE/Minorities/Females/Vet/Disability Employer Keyphrases:
correctional medical services jobs, correctional medicine jobs,
correctional health services jobs, prison health services jobs
Keywords: WellPath, Nashville , Correctional Medicine Claims Research Specialist Needed in Nashville,, Healthcare , Nashville, Tennessee
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